• Users Online: 995
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe News Contacts Login 

 Table of Contents  
Year : 2019  |  Volume : 3  |  Issue : 4  |  Page : 161-164

Treatment patterns of patients with schizophrenia based on the data from 44,836 outpatients in Russia

1 Depatment of Epidemiology, IQVIA, Frankfurt, Germany
2 Real World Evidence,IQVIA, Moscow, Russia
3 Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt, Germany

Date of Submission23-Oct-2019
Date of Acceptance26-Nov-2019
Date of Web Publication23-Dec-2019

Correspondence Address:
Dr. Karel Kostev
IQVIA, Unterschweinstiege 2.14, 60549 Frankfurt
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/hm.hm_73_19

Rights and Permissions

Aim: The goal of the present study was to estimate the treatment patterns in outpatients with schizophrenia in Russia. Methods: A total of 44,836 outpatients with schizophrenia treated by 812 psychiatrists in 2018 were selected in the LRx database in Russia. We descriptively analyzed the proportions of patients treated with different therapy classes and drugs. Results: Typical antipsychotics (58.2%) were the therapies with the highest patient proportion, followed by anti-Parkinson drugs (38.3%) and antidepressants (30.6%). The most frequent anti-Parkinson drug was trihexyphenidyl; the most frequent antidepressant was amitriptyline. Conclusions: The findings of this study imply that the proportion of older drugs is higher in schizophrenia therapy in Russia than reported based on samples in Europe and the U.S.

Keywords: Antidepressants, antiepileptics, antipsychotics, benzodiazepine, Russia, schizophrenia

How to cite this article:
Kostev K, Osina G, Konrad M. Treatment patterns of patients with schizophrenia based on the data from 44,836 outpatients in Russia. Heart Mind 2019;3:161-4

How to cite this URL:
Kostev K, Osina G, Konrad M. Treatment patterns of patients with schizophrenia based on the data from 44,836 outpatients in Russia. Heart Mind [serial online] 2019 [cited 2023 May 31];3:161-4. Available from: http://www.heartmindjournal.org/text.asp?2019/3/4/161/273851

  Introduction Top

Schizophrenia is a severe psychiatric disease with a relatively small prevalence of about 0.3% but a very high burden.[1] The prevalence of schizophrenia differs slightly between countries.[2] Some large countries like Russia have no published studies on the prevalence of schizophrenia among the general populations. Based on about 140 million inhabitants in Russia, it can be assumed that about 400,000 people live with schizophrenia in this country. Shaposhnikov and Sitchikhin reported that 354,790 patients with schizophrenia with a high degree of disability were registered in 2013 in Russia.[3]

With no cure for schizophrenia, the main goals of schizophrenia treatment include symptom targeting and relapse prevention.[4] Pharmacological therapy plays a very important role in the treatment of this disease, and several mono- and combination pharmacological therapies are available for treating schizophrenia symptoms. Antipsychotics are the first choice among psychotropic agents used to treat schizophrenia. For some patient groups, treatment strategies include the combination of neuroleptics and antiepileptics.[5] As the prevalence of depressive symptoms in patients with schizophrenia is relatively high, antidepressants are also often prescribed.[6] Moreover, some evidence supports the use of combination therapy with antipsychotics and benzodiazepines.[7] Finally, the use of certain anticholinergic drugs in conjunction with antipsychotics has been identified as an important topic in the treatment of schizophrenia.[8]

In recent years, several studies on real-world prescription patterns in schizophrenia have been published, which have enabled the evaluation of the efficacy and safety of therapy practices. Such studies were performed in the U.S,[9],[10],[11] China,[12] Japan,[13] Germany,[14] and seven Eastern European countries, including Croatia, Estonia, Hungary, Poland, Serbia, Slovakia, and Slovenia.[15] The methods and patient populations differed between the countries, but each study was an important investigation into the epidemiology of schizophrenia. Nevertheless, there are no studies that investigate the complete treatment patterns of outpatients with schizophrenia in Russia.

The goal of the present study was to estimate the treatment patterns in outpatients with schizophrenia in Russia, including all therapy classes prescribed to these patients.

  Methods Top

This retrospective cross-sectional study was based on the IQVIA Russia LRx database, which covers approximately 11% of all patients enrolled in federal or regional reimbursement state health-care programs. The data are properly anonymized (in accordance with federal law 152) and allow for longitudinal tracking of each patient via a unique patient ID. Other data attributes include age, sex, diagnosis, and prescription information (therapy with the indication of trade name, molecule, drug form, dosage, and manufacturer, region in which the drug was dispensed; prescription period) and prescriber specialty.

Patients with at least one prescription to treat schizophrenia (ICD-10: F20) from 812 psychiatrists in the time period between January 2018 and December 2018 were included in our analyses. No exclusion criteria were used. We analyzed the following therapy classes based on the anatomical classification of pharmaceutical products published by the European Pharmaceutical Market Research Association: atypical antipsychotics (Anatomical Therapeutic Chemical [ATC]: M05A1), typical antipsychotics (ATC: N05A9), antidepressants (ATC: N06A), antiepileptics (ATC: N03), benzodiazepines (N05C), and anticholinergic anti-Parkinson drugs (ATC: N04A).

We separately analyzed the proportions of patients with schizophrenia treated with each of these classes, both by monotherapy and combination therapy. Monotherapy was defined as the prescription of only one therapy class during the study period. Combination therapy was defined as the prescription of at least two of these classes in the same month (as no prescription days are available in the database). When a patient received several therapy combinations in different months throughout the year, the most recent combination was analyzed. In the second step, we analyzed the drugs prescribed to patients with schizophrenia.

This study is of a descriptive nature, and no hypotheses were tested. All analyses were carried out using SAS version 9.4 (SAS Institute, Cary, NC).

  Results Top

A total of 44,836 patients with schizophrenia who received medication therapy were available for the analysis. The mean age was 43.4 years (standard deviation [SD] 4.7 years) and 49.5% were women [Table 1]. Among all of them, 80.0% were treated with antipsychotics, with 58.2% receiving typical and 28.3% atypical antipsychotics [Figure 1]. The therapy with the highest patient proportion was typical antipsychotics, followed by anti-Parkinson drugs (38.3%) and antidepressants (30.6%).
Table 1: Basic characteristics of patients with schizophrenia in this study

Click here to view
Figure 1: Therapy classes prescribed to patients with schizophrenia in Russia in 2018. Monotherapy was defined as the prescription of only one therapy class during the study period. Combination therapy was defined as the prescription of at least two of these classes in the same month (as no prescription days are available in the database). When a patient received several therapy combinations in different months throughout the year, the most recent combination was analyzed

Click here to view

Anti-Parkinson drugs were prescribed to 42.0% of the patients treated with typical and 27.4% of the patients treated with atypical antipsychotics.

Antiepileptics were prescribed to 13.3% of the patients. Furthermore, only 13.5% of the patients received benzodiazepines as their current therapy [Figure 1], but 24.5% had received benzodiazepines at least once in 2018. Typical and atypical antipsychotics were the two therapy classes most often given as monotherapy, while the other therapy classes were mainly given in addition to antipsychotics [Figure 1].

When these drugs classes were prescribed at least one time, the mean numbers of prescriptions per patient during the year were as follows: atypical antipsychotics: 4.3 (SD: 2.9), typical antipsychotics: 4.5 (SD: 3.1), antidepressants: 4.0 (SD: 3.0), anti-Parkinson drugs: 4.6 (SD: 3.2), and benzodiazepines: 2.9 (SD: 2.4).

In patients treated with typical antipsychotics, haloperidol (30.2%), zuclopenthixol (16.3%), and chlorprothixene (13.7%) were the three most frequently prescribed drugs. Among atypical antipsychotics, clozapine (86.9%), risperidone (13.1%), and quetiapine (17.2%) were most frequently prescribed. Other relevant drugs were trihexyphenidyl (86.9% of the patients treated with anti-Parkinson drugs), amitriptyline (37.1% of the patients treated with antidepressants), phenazepam (85.2% of the patients treated with benzodiazepines), valproate (42.1% of the patients treated with antiepileptics), and carbamazepine (40.7% of the patients treated with antiepileptics) [Figure 2].
Figure 2: Drugs with a schizophrenia patient proportion of at least 10% of the therapy class. The denominators are patients with schizophrenia who have used that class of medication. For example, presumably, 85.2% of those prescribed benzodiazepines received phenazepam

Click here to view

  Discussion Top

Main findings

In this retrospective study of almost 45,000 individuals with schizophrenia, we found that the majority patients received antipsychotics. Typical antipsychotics were more frequently prescribed than atypical antipsychotics. The most common combination therapy included anti-Parkinson drugs and antidepressants, and the majority of patients received older generations of drugs.

Interpretation of the findings

One of the main findings of this study was the high proportion of patients treated with typical antipsychotics and the lower proportion of patients prescribed atypical antipsychotics. Some studies have shown that atypical antipsychotics are more beneficial than conventional drugs for cognitive dysfunction and also have fewer side effects.[16],[17] The few eligible trials suggested that clozapine may be more effective than other antipsychotics when used as first- or second-line treatment.[18]

Anticholinergic drugs are often used to reverse extrapyramidal symptoms that result from antipsychotic drug use. The prevalence of such symptoms is higher in patients receiving typical antipsychotics than in patients receiving atypical antipsychotics.[19] In the present study, anti-Parkinson drugs were given much more frequently to patients treated with typical antipsychotics than to patients treated with atypical antipsychotics, which may indicate that a higher proportion of patients treated with typical antipsychotics had extrapyramidal side effects. However, typical antipsychotics, as an older antipsychotic generation, are much more affordable and therefore have a higher share in the reimbursement segment.

Interestingly, the most frequently prescribed anti-Parkinson drug was trihexyphenidyl. This drug was shown to be effective in preventing or treating the extrapyramidal side effects of antipsychotics. However, anticholinergics can cause central adverse effects, which is why psychiatrists in Europe only rarely prescribe trihexyphenidyl today.[8] Anti-Parkinson drugs were not only prescribed in a high share of schizophrenia patients but also prescribed on average approximately five times/year. This prescription pattern is not usual, as these drugs are associated with several side effects.

The proportion of benzodiazepine prescriptions in patients with schizophrenia in Russia (24.5%) was slightly lower than the shares reported for the U.S. and Switzerland. Schuster et al. reported that the prevalence of benzodiazepine use was 29.8% in older patients with schizophrenia in Switzerland.[20] In the U.S. study, 27.5% of patients with schizophrenia were prescribed benzodiazepines as monotherapy or in addition to antipsychotics.[21] However, the prescribed drugs differ from country to country (phenazepam in Russia and diazepam and lorazepam in Europe and the U.S, respectively). Phenazepam is a benzodiazepine developed in the former Union der Sozialistischen Sowjetrepubliken (USSR) about 50 years ago and its toxicity is considered to be lower than that of other benzodiazepines. This drug has been often been prescribed in Russia for anxiolytic, sedative-hypnotic, or antiepileptic uses.[22]

The prevalence of antidepressant use in patients with schizophrenia has been reported in several studies.[23] The average prevalence of depressive symptoms in patients with schizophrenia is estimated to be about 25%. In a U.S. study by Himelhoch et al., 37% of patients with schizophrenia received antidepressants.[24] In Italy, a proportion of 40% was reported.[25] In Eastern European countries, 42% of patients with schizophrenia received antidepressants.[15] The prevalence of antidepressant use in the present study was 30.6%, which does not considerably differ from other published studies. However, the antidepressant drug class that was used was different. In the U.S., the share of selective serotonin (noradrenalin) reuptake inhibitors (SSRI/SNRI) was 85%,[24] in Italy, it was 55%,[25] and in Russia, it was 42.1%. Again, the reason may be the higher price of SSRI/SNRI therapy compared to such older antidepressant drugs as tricyclic antidepressants.

Strengths and limitations

The two major strengths of this study are the large sample size and the use of a pharmacy database. However, the findings of this study should be interpreted in the light of several limitations. First, as LRx is a prescription database, only treated patients could be analyzed, which can cause the prevalence of the use of defined drug classes to be overestimated. Moreover, the coverage of the data is 11%, and it is possible that patients in the covered regions have demographic, clinical, and therapy-related differences to patients in the noncovered regions. Second, this was a retrospective study, and missing data on disease severity and/or therapy compliance may have biased the subsequent descriptive analyses. Third, only pharmacological therapy was analyzed, as no data on psychotherapy were available. Finally, schizophrenia treatment patterns were analyzed in Russia, and these findings cannot be extrapolated to populations in other countries.

  Conclusions Top

The drug classes prescribed to outpatients with schizophrenia in Russia do not differ from those given in Europe or the U.S. However, the findings of this study imply that the proportion of older drugs in Russia is higher than reported based on samples in Europe and the U.S. Further studies are needed to identify the reasons why older generation drugs are prescribed in Russia.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: Findings from the global burden of disease study 2016. Schizophr Bull 2018;44:1195-203.  Back to cited text no. 1
Mura G, Petretto DR, Bhat KM, Carta MG. Schizophrenia: From epidemiology to rehabilitation. Clin Pract Epidemiol Ment Health 2012;8:52-66.  Back to cited text no. 2
Shaposhnikov NN, Sitchikhin PV. Dynamics and correlations of disability of adult population owing to schizophrenia with basic indicators of activity of mental health service. Kubanskij nauchnij medizinskij vestnik 2016;161:140-5.  Back to cited text no. 3
Kane JM, Correll CU. Pharmacologic treatment of schizophrenia. Dialogues Clin Neurosci 2010;12:345-57.  Back to cited text no. 4
Hosák L, Libiger J. Antiepileptic drugs in schizophrenia: A review. Eur Psychiatry 2002;17:371-8.  Back to cited text no. 5
Helfer B, Samara MT, Huhn M, Klupp E, Leucht C, Zhu Y, et al. Efficacy and safety of antidepressants added to antipsychotics for schizophrenia: A systematic review and meta-analysis. Am J Psychiatry 2016;173:876-86.  Back to cited text no. 6
Szarmach J, Włodarczyk A, Cubała WJ, Wiglusz MS. Benzodiazepines as adjunctive therapy in treatment refractory symptoms of schizophrenia. Psychiatr Danub 2017;29:349-52.  Back to cited text no. 7
Ogino S, Miyamoto S, Miyake N, Yamaguchi N. Benefits and limits of anticholinergic use in schizophrenia: Focusing on its effect on cognitive function. Psychiatry Clin Neurosci 2014;68:37-49.  Back to cited text no. 8
Yu AP, Ben-Hamadi R, Birnbaum HG, Atanasov P, Stensland MD, Philips G. Comparing the treatment patterns of patients with schizophrenia treated with olanzapine and Quetiapine in the Pennsylvania Medicaid population. Curr Med Res Opin 2009;25:755-64.  Back to cited text no. 9
Fisher MD, Reilly K, Isenberg K, Villa KF. Antipsychotic patterns of use in patients with schizophrenia: Polypharmacy versus monotherapy. BMC Psychiatry 2014;14:341.  Back to cited text no. 10
Joshi K, Lafeuille MH, Brown B, Wynant W, Emond B, Lefebvre P, et al. Baseline characteristics and treatment patterns of patients with schizophrenia initiated on once-every-three-months paliperidone palmitate in a real-world setting. Curr Med Res Opin 2017;33:1763-72.  Back to cited text no. 11
Hou CL, Wang SB, Wang F, Xu MZ, Chen MY, Cai MY, et al. Psychotropic medication treatment patterns in community-dwelling schizophrenia in China: Comparisons between rural and urban areas. BMC Psychiatry 2019;19:242.  Back to cited text no. 12
Jamotte A, Clay E, Aballéa S, Onishi Y, Toumi M. Treatment patterns and health care costs in patients with schizophrenia initiating with first-or second-generation antipsychotic: Results from a Japanese claims database analysis. Value Health 2014;17:A466.  Back to cited text no. 13
Toto S, Grohmann R, Bleich S, Frieling H, Maier HB, Greil W, et al. Psychopharmacological treatment of schizophrenia over time in 30 908 inpatients: Data from the AMSP study. Int J Neuropsychopharmacol 2019;22:560-73.  Back to cited text no. 14
Szkultecka-Dębek M, Miernik K, Stelmachowski J, Jakovljević M, Jukić V, Aadamsoo K, et al. Treatment patterns of schizophrenia based on the data from seven central and Eastern European countries. Psychiatr Danub 2016;28:234-42.  Back to cited text no. 15
Davis JM, Chen N, Glick ID. A meta-analysis of the efficacy of second-generation antipsychotics. Arch Gen Psychiatry 2003;60:553-64.  Back to cited text no. 16
Faay MD, Czobor P, Sommer IE. Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: A review and meta-analysis. Neuropsychopharmacology 2018;43:2340-9.  Back to cited text no. 17
Okhuijsen-Pfeifer C, Huijsman EA, Hasan A, Sommer IE, Leucht S, Kahn RS, et al. Clozapine as a first-or second-line treatment in schizophrenia: A systematic review and meta-analysis. Acta Psychiatr Scand 2018;138:281-8.  Back to cited text no. 18
Naja WJ, Halaby A. Anticholinergic use and misuse in psychiatry: A comprehensive and critical review. J Alcohol Drug Depend 2017;5:2.  Back to cited text no. 19
Schuster JP, Hoertel N, von Gunten A, Seigneurie AS, Limosin F; CSA Study Group. Benzodiazepine use among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. Int Psychogeriatr 2019;7:1-11.  Back to cited text no. 20
Fontanella CA, Campo JV, Phillips GS, Hiance-Steelesmith DL, Sweeney HA, Tam K, et al. Benzodiazepine use and risk of mortality among patients with schizophrenia: A retrospective longitudinal study. J Clin Psychiatry 2016;77:661-7.  Back to cited text no. 21
Kriikku P, Wilhelm L, Rintatalo J, Hurme J, Kramer J, Ojanperä I. Phenazepam abuse in Finland: Findings from apprehended drivers, post-mortem cases and police confiscations. Forensic Sci Int 2012;220:111-7.  Back to cited text no. 22
Mao YM, Zhang MD. Augmentation with antidepressants in schizophrenia treatment: Benefit or risk. Neuropsychiatr Dis Treat 2015;11:701-13.  Back to cited text no. 23
Himelhoch S, Slade E, Kreyenbuhl J, Medoff D, Brown C, Dixon L. Antidepressant prescribing patterns among VA patients with schizophrenia. Schizophr Res 2012;136:32-5.  Back to cited text no. 24
Bianchi S, Bianchini E, Scanavacca P. Use of antipsychotic and antidepressant within the psychiatric disease centre, regional health service of Ferrara. BMC Clin Pharmacol 2011;11:21.  Back to cited text no. 25


  [Figure 1], [Figure 2]

  [Table 1]

This article has been cited by
1 Respiratory aspiration during treatment with clozapine and other antipsychotics: a literature search and a pharmacovigilance study in VigiBase
Carlos De las Cuevas, Emilio J. Sanz, Alejandro G. Villasante-Tezanos, Jose de Leon
Expert Opinion on Drug Metabolism & Toxicology. 2023;
[Pubmed] | [DOI]
2 Clozapine-induced myocarditis in Russia: Animal studies but no clinical studies
Oleg O. Kirilochev, Carlos De las Cuevas, Jose de Leon
Revista de Psiquiatría y Salud Mental (English Edition). 2022; 15(4): 294
[Pubmed] | [DOI]
3 Clozapine-induced myocarditis in Russia: Animal studies but no clinical studies
Oleg O. Kirilochev,Carlos De las Cuevas,Jose de Leon
Revista de Psiquiatría y Salud Mental. 2021;
[Pubmed] | [DOI]
4 Off-label antipsychotics prescription to adolescents with acute psychotic episodes does not cause adverse drug reactions
D. V. Ivashchenko,N. I. Buromskaya,A. D. Malakhova,N. A. Tsarkova,L. M. Savchenko,Yu. S. Shevchenko,D. A. Sychev
Neurology, Neuropsychiatry, Psychosomatics. 2021; 13(3): 19
[Pubmed] | [DOI]
5 Functioning Problems in Persons with Schizophrenia in the Russian Context
Manuel Rojas,Maite Barrios,Juana Gómez-Benito,Nadezhda Mikheenkova,Sergey Mosolov
International Journal of Environmental Research and Public Health. 2021; 18(19): 10276
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded1778    
    Comments [Add]    
    Cited by others 5    

Recommend this journal